Request a Divvy Card

Request a Divvy Card

Please note that a $5 charge will be added to your account for a new Divvy/Bill card.
Name*

First NameLast Name
Email (Please use email associated with driver profile)*
example@example.com
What city do you deliver in?*
Briefly describe what happened to your original card*
Mailing Address (Please be sure address is correct)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Thank you for your request!

Your card will be mailed to the address listed above. Please note that if address is not correct you will have to order and pay for a new card.
Should be Empty: